Implementation strategies to reduce surgical site infections: A systematic review

Abstract

Background:Surgical site infections (SSIs) portend high patient morbidity and mortality. Although evidence-based clinical interventions can reduce SSIs, they are not reliably delivered in practice, and data are limited on the best approach to improve adherence.Objective:To summarize implementation strategies aimed at improving adherence to evidence-based interventions that reduce SSIs.Design:Systematic reviewMethods:We searched PubMed, Embase, CINAHL, the Cochrane Library, the WHO Regional databases, AFROLIB, and Africa-Wide for studies published between January 1990 and December 2015. The Effective Practice and Organization Care (EPOC) criteria were used to identify an acceptable-quality study design. We used structured forms to extract data on implementation strategies and grouped them into an implementation model called the “Four Es” framework (ie, engage, educate, execute, and evaluate).Results:In total, 125 studies met our inclusion criteria, but only 8 studies met the EPOC criteria, which limited our ability to identify best practices. Most studies used multifaceted strategies to improve adherence with evidence-based interventions. Engagement strategies included multidisciplinary work and strong leadership involvement. Education strategies included various approaches to introduce evidence-based practices to clinicians and patients. Execution strategies standardized the interventions into simple tasks to facilitate uptake. Evaluation strategies assessed adherence with evidence-based interventions and patient outcomes, providing feedback of performance to providers.Conclusions:Multifaceted implementation strategies represent the most common approach to facilitating the adoption of evidence-based practices. We believe that this summary of implementation strategies complements existing clinical guidelines and may accelerate efforts to reduce SSIs.

<p>Optimizing compliance with surgical antimicrobial prophylaxis guidelines in patients undergoing gastrointestinal surgery at a referral teaching hospital in southern Iran: clinical and economic impact</p>

“…11 Despite this, studies have shown that optimal practice is not achieved in many hospitals, especially in developing countries. 12,13 The knowledge and attitudes of surgeons about appropriate SAP are important factors in the implementation of guidelines. It is necessary for hospital administrators and institutional quality-improvement departments to provide approaches to reduce such outcomes of antibiotic overuse as increased antibiotic resistance and higher financial costs to hospitals.…”

Implementation interventions in preventing surgical site infections in abdominal surgery: a systematic review

“…The results regarding the distribution of implementation interventions applied are mostly consistent with findings from other reviews. Most prominently, the review by Ariyo et al on implementation strategies in SSI prevention also generally found multidisciplinary work, Note: * only studies reporting both baseline and cohort SSI rates educational approaches, and monitoring and feedback among the foremost interventions in the 125 studies they included [23]. Additionally, Borgert and colleagues, who examined intensive care bundles [28], and Wuchner, who examined translating evidence into nursing practices [74], found educational measures, reminders, and audit and feedback to be most frequently used.…”

“…Regarding SSI prevention in particular, Ariyo and colleagues have conducted a systematic review on utilized implementation strategies [23]. They categorize implementation interventions using the "four Es" approach [24,25], which describes "engage, "educate", "execute" and "evaluate" as the basic components of change management.…”

Rapid and economical detection of eight carbapenem-resistance genes in Enterobacteriaceae, Pseudomonas spp, and Acinetobacter spp directly from positive blood cultures using an internally controlled multiplex-PCR assay

“…Rapid and economical detection of eight carbapenem-resistance genes in Enterobacteriaceae, Pseudomonas spp, and Acinetobacter spp directly from positive blood cultures using an internally controlled multiplex-PCR assay especially in healthcare settings. 1,2 Carbapenem resistance challenges empirical and targeted antibiotic treatment involving βlactam antibiotics, including carbapenems, and it results in expensive and complicated alternative anti-infective strategies with polymyxin-B, colistin, tigecycline, and fosfomycin. 3 Despite their high cost (∼US$62 per test), commercially available PCR-based tests have been used to screen clinically important carbapenemases, known as the "Big 5" genes: metallo-β-lactamases (MBLs) (ie, NDM, IMP, and VIM), KPC, and the OXA-48 family.…”

“…To the Editor-Polymyxin B is an old class of nonribosomal cyclic lipopeptide antibiotics that has been used for the treatment of gram-negative bacterial infection such as multidrug-resistant Pseudomonas aeruginosa, especially carbapenem-resistant isolates. 1 Bacteria are usually able to evolve different strategies to sense, respond, and adapt to bactericidal agents including polymyxins. Although biofilm is a well-established response strategy to an antimicrobial agent, little is known about the impact of biofilms produced by P. aeruginosa regarding polymyxin susceptibility.…”